The present invention relates to a surgical instrument to be used in certain endoscopic surgical operations, such as in laparoscopic surgery, in order to extract a specimen, such as an organ or tissue.
Laparoscopic surgery, also known as keyhole surgery, has gained increasing importance within general surgery and gynaecological surgery. The advantages obtained compared with conventional surgery are considerable to the patient and society alike. In laparoscopic surgery small puncture orifices are made in the abdominal wall through which trocars (tubular sleeves) are inserted, said trocars serving as a means for introduction of the laparoscopic instrument as well as one or several working instruments. The abdomen is inflated by gas, which increases the abdominal volume considerably, allowing survey and accessibility. The image of the surgical area is transmitted to a monitor and the disordered organ is isolated and separated from surrounding tissue with the aid of the operational instrument. The surgical technique, instrument and other equipment used for this purpose are well known and highly developed. The specimen (organ, surgically removed tissue) is then to be removed from the abdomen. When the specimen is small-sized it may be extracted through a trocar directly but when the specimen is large it is either necessary to open the abdomen by making an incision therein (thus reducing the advantages gained by the laparoscopic surgical operation) or to fragmentize (morcellate) the specimen. Instruments for this purpose (morcellaters) have been known for several decades (for example the instrument known as Serrated edge Macro Morcellator xe2x80x9cSEMMxe2x80x9d manufactured by Wisarp in Germany) and in recent years several models have been developed. A morcellator of this kind is described for instance in U.S. Pat. No. 5,443,472 comprising two rods which are carried down into the abdomen and one of which comprises a net which may be gathered together and which is positioned in such a manner as to extend around the other rod and the specimen. The second rod comprises an outer tube having an opening therein and an inner tube having a cutting edge. When the net is gathered together a part of the specimen is forced to enter through the opening, whereupon the inner tube is forced downwards and cuts off the protruding part of the specimen, the inner tube is withdrawn, and the procedure may be repeated.
The problem connected with this and other morcellators are, however, considerable. This is due essentially to the fact that
the specimen, such as an organ or tissue, at best is only partly enclosed by a retaining device;
consequently the specimen is insufficiently fixed;
reconstruction of the specimen after morcellation is not possible; and
there is no safe barrier between the morcellator and the abdomen.
The consequences are several:
1. The fragments of the specimen, such as an organ or tissue, cannot be cut from the specimen in a planned and optimum manner.
2. The morcellation is a lengthy operation, or cannot be carried out at all if the specimen is very large.
3. In the finishing phase the specimen is cut through from several directions and consequently limp and difficult to handle.
4. It may be difficult, even impossible, for the pathologist to correctly assess the specimen microscopically, since the specimen is presented to him in fragments that cannot be orientated relative to one another, and one consequence thereof is that the laparoscopic surgical technique is unsuitable for example for certain types of cancer surgery.
5. Damage may be made to surrounding organs (for example intestines and blood vessels) during the morcellation since there is no safe barrier between on the one hand the morcellator and the specimen and on the other the abdominal cavity.
6. Waste from the specimen may contaminate the abdominal cavity or the abdominal wall (infected specimen, cancer cells).
Also when the specimen, such as an organ or tissue, is small and should not need to be fragmentized extraction thereof could nonetheless be difficult using prior art equipment. Prior art equipment often comprises a bag or sack of some kind which is introduced into the abdomen through the trocar. When the specimen is entrapped and the equipment is pulled upwards it may, however, be deformed in an unfavourable manner or assume an oblique position, making it impossible to extract it through the trocar.
These and other problems are complicating features of the laparoscopic surgery and restrict its use and application. Under corresponding conditions the above is applicable also to the operative thorascopy (keyhole surgery in the thoracic cavity).
The object of the present invention is to provide a device to be used in endoscopic surgical operations in order to extract a specimen, such as an organ or tissue, which device wholly or completely obviates the above-mentioned problems connected with the prior art technology. This object is achieved by means of a device as defined in claim 1.